March 17, 2014

Post #2 in the Discussion of the Evidence Base for Music Therapy in the Treatment of Mental Illnesses - Reply by Music Therapy Maven founder Kimberly Sena Moore

A few days ago, I posted an initial article from a planned discussion about the evidence base for music therapy in the treatment of mental illnesses. I received an invitation from Kimberly Sena Moore, who runs the Music Therapy Maven blog, to have a dialogue on this issue after I had a back-and-forth with some folks on the Facebook feed for Ben Folds on this issue. Below is her reply to my initial post (click here to read my article). As I noted before, Kimberly and I encourage readers from all perspectives to post their thoughts in the comments section. One of the many things I appreciate about this exchance is the cordial and respectful tone and I'm hopeful readers can keep that momentum going.

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Musings on the State of Music Therapy Research: Strengths, Challenges, and Future Directions

by Kimberly Sena Moore

Earlier this month I invited Dr. Michael Anestis, a clinical psychologist and researcher, to share his perspectives on music therapy research. By his own admission, his area of focus is mental health research—which omits the medical, rehabilitation, developmental, wellness, and preventive areas of focus in music therapy research—but I felt he had fair and valid points that I am sure are not unique to him. So I asked Michael to share his thoughts on the Music Therapy Maven (link), following which I would write a response.

I am approaching my response from a couple of different perspectives. First is as a researcher. I have spent the last several years seeped in research, music therapy and otherwise, reading, analyzing, critiquing, and having conversations about the current status of our research literature and directions it seems to be heading. The second is as a music therapy advocate. It is a perpetual challenge in our field to disseminate and share our knowledge in a way that is accessible and understood by non-music therapists. The sentiment that “oh, you’re a music therapist, isn’t that nice?” can extend to our research. I would like to think that this perception is shifting, especially as our understanding of music’s influence on brain and behavior function continues to deepen, and I feel dialogues like this can go a long way towards advocating for our profession and its research.

In reading Michael’s post, his primary concern seems to be that our mental health research does not meet his (and others’) definition of having a strong evidence base. These characteristics include having multiple large trials, randomly controlled trials, reporting long term effects, and clear intervention reporting with a transparent description of interventionist training and an intervention manual. Furthermore, he is wary of music therapy’s ability to treat mental illnesses (which admittedly I am to, but I also don’t feel any one type of therapy—drug, verbal, cognitive, creative or otherwise—can alone “treat” mental illnesses, but that’s another conversation...).

I feel we should first acknowledge and feel proud of what the music therapy profession has accomplished research-wise. Our early leaders made an intentional effort to focus on developing a research base and we have accumulated a large body of literature in our almost 65-year history. Furthermore, we have accomplished this in spite of some real challenges. One of those challenges is numbers. Although our profession shows steady growth, we are still just shy of having 6,000 board certified music therapists in the country. And how many of those are conducting research? Furthermore, we are a broad field that works across multiple ages, treatment domains, and diagnoses. Although an individual music therapist will not practice that broadly, our collective body of literature is spread thin between the mental health, medical, behavioral, developmental, educational, wellness, preventive, and neurorehabilitative fields.

All this is not to provide excuses, but to acknowledge that, yes, we have had challenges and there are some very real areas in which we can and need to improve our research output. We need to continue our efforts to build a stronger base of evidence. Part of this relates to the criteria Michael laid out, such as incorporating larger Ns, conducting multisite studies, and reporting long-term effects. But that is also not the only criteria through which to judge a body of evidence. Evidence is also strengthened by conducting quality research that is intentionally laid out, theory-based, and transparent.

Below are 5 ways that I feel that music therapy research could be strengthened and pushed to the next level. As you may glean, I don’t feel the answer lies in jumping to large, randomly controlled clinical studies. Though these are an important form of evidence, I feel we also need to work on improving the quality and depth of our research, leveraging what has been done in the past, and building on the larger literature base. These ideas are not unique to me as other music therapy researchers are writing, producing, and discussing these. They also may not be the ONLY ways to improve our output. But I do feel they warrant mention and serious consideration.

1) More Music Therapy-Focused Systematic Reviews

A systematic review is like a super-strength literature review. There are many different types of systematic reviews (e.g. meta-analysis, meta-synthesis, Cochrane review, narrative synthesis, and more), but they share common features, such as creating a clearly defined research question and conducting the review in a methodologically rigorous way. The intention of a systematic review is not only to review the literature on a given research question, but to synthesize the results and use that synthesize to make informed, evidence-based decisions regarding clinical treatment and future research directions.

The appeal of conducting systematic reviews in music therapy is that it allows the researcher to leverage research already completed, then combine and synthesize the results, allowing for the possibility of, among other things, the creation of new knowledge or a more clearly understood grasp of music therapy intervention efficacy. In other words, it builds new evidence based on what has been done before.

For more information about systematic reviews, the upcoming issue of the Journal of Music Therapy will include an article I co-authored defining and describing the process to conduct a systematic review (Hanson-Abromeit & Sena Moore, in press).

2) Conducting Translational Research

Translational research is that which takes information from basic science research and translates it for practical, clinical study or use. With music therapy, this may involve, for example, taking research from the music perception and cognition literature and using it to inform the creation and/or study of a music therapy intervention. As with systematic reviews, part of the appeal of conducting translational research is that it allows one to leverage previously existing information. Furthermore it builds knowledge from the bottom up as the foundational framework is based in scientific evidence.

As I understand it, theoretical and conceptual frameworks are very closely related and there is not a single agreed-upon definition for either. Ultimately, though, each relates to using the existing literature to support a line of inquiry by identifying the research variables and relationships between them prior to conducting the study. Thus the researcher has identified what is needs to be studied or measured and, more importantly, why. In music therapy-speak, this is similar to the difference between choosing an intervention or song because you think the client will like it or it will be “fun” and choosing a particular intervention because it is the most appropriate for a given client need at that time. Developing a conceptual framework is time-intensive—from personal experience it takes a lot of reading, writing, synthesis, processing, dialogues, and a willingness to be patient with the process—but ultimately it will lead to higher quality research due to the depth involved in developing the framework.

Click here to read more about the importance of conceptual and theoretical frameworks.

4) Engaging in Collaborative Research

As indicated earlier, the music therapy profession has a challenge with numbers. There are almost 6,000 board certified music therapists in the state—much less than many other healthcare and education professionals, I imagine—and a small percentage are trained researchers. Plus, to state it simply, the academics in our field have the knowledge of research and research process, but the clinicians in the field are working with the clients. It makes sense, then, to combine forces and develop more collaborative clinician-academic research projects. I have started to see more collaborative music therapy research occurring and expect more will happen in future years. What’s the benefit of encouraging or promoting this type of research? In addition to the benefits of working with an interdisciplinary research team where each person brings his or her own sets of skills, experiences, and resources, conducting collaborative research allows the possibility for more research to be conducted as it opens the doors for non-academics to participate in research.

5) More Transparent Intervention Reporting

Music therapy is a complex profession, as are other therapies that work with human behavior. In these fields and others there is a call for more transparent intervention reporting. What does this mean? It means that researchers are being called to describe any treatment intervention in an explicit and detailed fashion. In music therapy research this means detailing not just how the music and/or music experience is facilitated (e.g. tempo, melody, lyrics, instruments, intervention steps), but also any elements of therapist effectiveness. The benefits of incorporating explicit intervention reporting is that it will accomplish not only a real opportunity to replicate studies, but also the ability to break down the music therapy treatment and analyze exactly what was contributing to client (or study participant) change.

Click here for more information about the importance of transparent music therapy intervention reporting.

Conclusion

The song “We’ve Come a Long Way Baby” comes to mind when I think about music therapy research. We HAVE come a long way in our 65-year history, but we’re also not finished. There are some real and significant ways in which we can improve the quality and depth of our research output and continue to develop a strong base of evidence. I am one of many who are having these conversations and making these changes. If you have ideas or suggestions to contribute to this conversation, please share them in the comment section below.

About the Author: Kimberly Sena Moore, MM, MT-BC is a board certified music therapist and a Ph.D. Candidate at the University of Missouri-Kansas City, where her clinical and research interests center on music therapy and emotion regulation development in neurodevelopmentally at-risk children. Through her role as Regulatory Affairs Associate for the Certification Board for Music Therapists, she is involved in state-level advocacy, legislative, and policy issues affecting music therapy practice. Online, Kimberly co-hosts the Music Therapy Round Table podcast, and blogs at Your Musical Self for Psychology Today and Music Therapy Maven

Comments

Post #2 in the Discussion of the Evidence Base for Music Therapy in the Treatment of Mental Illnesses - Reply by Music Therapy Maven founder Kimberly Sena Moore

A few days ago, I posted an initial article from a planned discussion about the evidence base for music therapy in the treatment of mental illnesses. I received an invitation from Kimberly Sena Moore, who runs the Music Therapy Maven blog, to have a dialogue on this issue after I had a back-and-forth with some folks on the Facebook feed for Ben Folds on this issue. Below is her reply to my initial post (click here to read my article). As I noted before, Kimberly and I encourage readers from all perspectives to post their thoughts in the comments section. One of the many things I appreciate about this exchance is the cordial and respectful tone and I'm hopeful readers can keep that momentum going.

************

Musings on the State of Music Therapy Research: Strengths, Challenges, and Future Directions

by Kimberly Sena Moore

Earlier this month I invited Dr. Michael Anestis, a clinical psychologist and researcher, to share his perspectives on music therapy research. By his own admission, his area of focus is mental health research—which omits the medical, rehabilitation, developmental, wellness, and preventive areas of focus in music therapy research—but I felt he had fair and valid points that I am sure are not unique to him. So I asked Michael to share his thoughts on the Music Therapy Maven (link), following which I would write a response.

I am approaching my response from a couple of different perspectives. First is as a researcher. I have spent the last several years seeped in research, music therapy and otherwise, reading, analyzing, critiquing, and having conversations about the current status of our research literature and directions it seems to be heading. The second is as a music therapy advocate. It is a perpetual challenge in our field to disseminate and share our knowledge in a way that is accessible and understood by non-music therapists. The sentiment that “oh, you’re a music therapist, isn’t that nice?” can extend to our research. I would like to think that this perception is shifting, especially as our understanding of music’s influence on brain and behavior function continues to deepen, and I feel dialogues like this can go a long way towards advocating for our profession and its research.

In reading Michael’s post, his primary concern seems to be that our mental health research does not meet his (and others’) definition of having a strong evidence base. These characteristics include having multiple large trials, randomly controlled trials, reporting long term effects, and clear intervention reporting with a transparent description of interventionist training and an intervention manual. Furthermore, he is wary of music therapy’s ability to treat mental illnesses (which admittedly I am to, but I also don’t feel any one type of therapy—drug, verbal, cognitive, creative or otherwise—can alone “treat” mental illnesses, but that’s another conversation...).

I feel we should first acknowledge and feel proud of what the music therapy profession has accomplished research-wise. Our early leaders made an intentional effort to focus on developing a research base and we have accumulated a large body of literature in our almost 65-year history. Furthermore, we have accomplished this in spite of some real challenges. One of those challenges is numbers. Although our profession shows steady growth, we are still just shy of having 6,000 board certified music therapists in the country. And how many of those are conducting research? Furthermore, we are a broad field that works across multiple ages, treatment domains, and diagnoses. Although an individual music therapist will not practice that broadly, our collective body of literature is spread thin between the mental health, medical, behavioral, developmental, educational, wellness, preventive, and neurorehabilitative fields.

All this is not to provide excuses, but to acknowledge that, yes, we have had challenges and there are some very real areas in which we can and need to improve our research output. We need to continue our efforts to build a stronger base of evidence. Part of this relates to the criteria Michael laid out, such as incorporating larger Ns, conducting multisite studies, and reporting long-term effects. But that is also not the only criteria through which to judge a body of evidence. Evidence is also strengthened by conducting quality research that is intentionally laid out, theory-based, and transparent.

Below are 5 ways that I feel that music therapy research could be strengthened and pushed to the next level. As you may glean, I don’t feel the answer lies in jumping to large, randomly controlled clinical studies. Though these are an important form of evidence, I feel we also need to work on improving the quality and depth of our research, leveraging what has been done in the past, and building on the larger literature base. These ideas are not unique to me as other music therapy researchers are writing, producing, and discussing these. They also may not be the ONLY ways to improve our output. But I do feel they warrant mention and serious consideration.

1) More Music Therapy-Focused Systematic Reviews

A systematic review is like a super-strength literature review. There are many different types of systematic reviews (e.g. meta-analysis, meta-synthesis, Cochrane review, narrative synthesis, and more), but they share common features, such as creating a clearly defined research question and conducting the review in a methodologically rigorous way. The intention of a systematic review is not only to review the literature on a given research question, but to synthesize the results and use that synthesize to make informed, evidence-based decisions regarding clinical treatment and future research directions.

The appeal of conducting systematic reviews in music therapy is that it allows the researcher to leverage research already completed, then combine and synthesize the results, allowing for the possibility of, among other things, the creation of new knowledge or a more clearly understood grasp of music therapy intervention efficacy. In other words, it builds new evidence based on what has been done before.

For more information about systematic reviews, the upcoming issue of the Journal of Music Therapy will include an article I co-authored defining and describing the process to conduct a systematic review (Hanson-Abromeit & Sena Moore, in press).

2) Conducting Translational Research

Translational research is that which takes information from basic science research and translates it for practical, clinical study or use. With music therapy, this may involve, for example, taking research from the music perception and cognition literature and using it to inform the creation and/or study of a music therapy intervention. As with systematic reviews, part of the appeal of conducting translational research is that it allows one to leverage previously existing information. Furthermore it builds knowledge from the bottom up as the foundational framework is based in scientific evidence.

As I understand it, theoretical and conceptual frameworks are very closely related and there is not a single agreed-upon definition for either. Ultimately, though, each relates to using the existing literature to support a line of inquiry by identifying the research variables and relationships between them prior to conducting the study. Thus the researcher has identified what is needs to be studied or measured and, more importantly, why. In music therapy-speak, this is similar to the difference between choosing an intervention or song because you think the client will like it or it will be “fun” and choosing a particular intervention because it is the most appropriate for a given client need at that time. Developing a conceptual framework is time-intensive—from personal experience it takes a lot of reading, writing, synthesis, processing, dialogues, and a willingness to be patient with the process—but ultimately it will lead to higher quality research due to the depth involved in developing the framework.

Click here to read more about the importance of conceptual and theoretical frameworks.

4) Engaging in Collaborative Research

As indicated earlier, the music therapy profession has a challenge with numbers. There are almost 6,000 board certified music therapists in the state—much less than many other healthcare and education professionals, I imagine—and a small percentage are trained researchers. Plus, to state it simply, the academics in our field have the knowledge of research and research process, but the clinicians in the field are working with the clients. It makes sense, then, to combine forces and develop more collaborative clinician-academic research projects. I have started to see more collaborative music therapy research occurring and expect more will happen in future years. What’s the benefit of encouraging or promoting this type of research? In addition to the benefits of working with an interdisciplinary research team where each person brings his or her own sets of skills, experiences, and resources, conducting collaborative research allows the possibility for more research to be conducted as it opens the doors for non-academics to participate in research.

5) More Transparent Intervention Reporting

Music therapy is a complex profession, as are other therapies that work with human behavior. In these fields and others there is a call for more transparent intervention reporting. What does this mean? It means that researchers are being called to describe any treatment intervention in an explicit and detailed fashion. In music therapy research this means detailing not just how the music and/or music experience is facilitated (e.g. tempo, melody, lyrics, instruments, intervention steps), but also any elements of therapist effectiveness. The benefits of incorporating explicit intervention reporting is that it will accomplish not only a real opportunity to replicate studies, but also the ability to break down the music therapy treatment and analyze exactly what was contributing to client (or study participant) change.

Click here for more information about the importance of transparent music therapy intervention reporting.

Conclusion

The song “We’ve Come a Long Way Baby” comes to mind when I think about music therapy research. We HAVE come a long way in our 65-year history, but we’re also not finished. There are some real and significant ways in which we can improve the quality and depth of our research output and continue to develop a strong base of evidence. I am one of many who are having these conversations and making these changes. If you have ideas or suggestions to contribute to this conversation, please share them in the comment section below.

About the Author: Kimberly Sena Moore, MM, MT-BC is a board certified music therapist and a Ph.D. Candidate at the University of Missouri-Kansas City, where her clinical and research interests center on music therapy and emotion regulation development in neurodevelopmentally at-risk children. Through her role as Regulatory Affairs Associate for the Certification Board for Music Therapists, she is involved in state-level advocacy, legislative, and policy issues affecting music therapy practice. Online, Kimberly co-hosts the Music Therapy Round Table podcast, and blogs at Your Musical Self for Psychology Today and Music Therapy Maven

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